Stent delivery device

ABSTRACT

Provided is a stent delivery device that can rapidly transport a stent to an indwelling site. In one aspect, the stent delivery device includes a catheter including an inner sheath and an outer sheath allowing the inner sheath to be slidably inserted therethrough and a stent provided between the inner sheath and the outer sheath in the vicinity of a distal end of the catheter. The stent delivery device also includes a guiding elongated body inserted through an inner lumen of the inner sheath and partially exposed from the distal end of the catheter so as to guide the insertion of the catheter. The guiding elongated body has a variable tip area provided in the vicinity of a distal end of the guiding elongated body so as to change flexibility between a first state and a second state different from the first state.

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/496,395 filed on Sep. 20, 2019, which is a national phase applicationof PCT/JP2018/012453 filed on Mar. 27, 2018, which claims priority toJapanese Patent Application No. 2017-072834 filed on Mar. 31, 2017, thecontents of each of which are hereby incorporated by reference in theirentirety.

BACKGROUND Technical Field

The present invention relates to a stent delivery device whichtransports a stent to an indwelling site in a body and indwells thestent at that site.

Description of the Related Art

In recent years, there have been sporadic cases of reports of endoscopicultrasound-guided transduodenal (or transgastric transhepatic) biliarydrainage (EUS-BD) when transduodenal papillary approaches are notavailable in the case of unresectable malignant biliary stricture orobstruction that requires biliary drainage. The EUS-BD is a procedure inwhich an ultrasound endoscope is inserted into a duodenum (or stomach),a common bile duct (or intrahepatic bile duct) is punctured by apuncture needle from a duodenum (or stomach) wall while observing anultrasound image in real time, a guide wire is inserted into the bileduct through the punctured hole, and a tubular object corresponding to abypass route connecting the duodenum (or stomach) and the common bileduct (or intrahepatic bile duct) is inserted and indwelled along theguide wire. By this procedure, biliary drainage can be achieved byimplanting the tubular object into the body.

A self-expanding stent provided with a covering film may be used as thetubular object used as the bypass route in such EUS-BD. As a stentdelivery device used in this case, for example, one including a catheterwith an inner sheath and an outer sheath allowing the inner sheath to beslidably inserted therethrough is known. Here, a stent is disposed in astent placement portion provided in the vicinity of a distal end of theinner sheath and the stent is held in a contracted state inside thevicinity of the distal end of the outer sheath. Further, when the outersheath is slid to be pulled out from the inner sheath at the proximalend side of the catheter, the stent is expanded.

For example, when the stomach is bypass-connected to the intrahepaticbile duct, the puncture needle forms a hole from the stomach wallthrough an abdominal cavity to the intrahepatic bile duct and the guidewire is inserted to secure the route. Then, the punctured hole isexpanded by a dilator to a degree that the distal end portion of thecatheter is inserted thereinto and the distal end portion of thecatheter (the stent placement portion) is inserted through the puncturedhole. Subsequently, when the outer sheath is pulled out in this stateand the stent is released (exposed and expanded), the stent is indwelledin the punctured hole.

In the EUS-BD, since such a complex procedure is performed, a stentdelivery device capable of rapidly transporting a stent is required. Forexample, Patent Document 1 proposes a catheter of which a distal side isprovided with a distal end tip having a high modulus material on thedistal side and a low modulus material on the proximal side. As aresult, since the distal end tip has high piercing ability (pushability)and flexibility, the catheter can be inserted smoothly without damaginga body lumen.

CITATION LIST Patent Document

-   Patent Document 1: JP 2014-195556 A

SUMMARY Problem to be Solved by the Invention

The invention has been made in view of such circumstances and an objectof the invention is to provide a stent delivery device capable ofrapidly delivering a stent to an indwelling site.

Means for Solving Problem

In order to attain the above-described object, a stent delivery deviceaccording to the invention includes: a catheter which includes an innersheath and an outer sheath allowing the inner sheath to be slidablyinserted therethrough; a stent which is provided between the innersheath and the outer sheath in the vicinity of a distal end of thecatheter; and a guiding elongated body which is inserted through aninner lumen of the inner sheath and is capable of partially exposed fromthe distal end of the catheter so as to guide the insertion of thecatheter, in which the guiding elongated body has a variable tip areaprovided in the vicinity of a distal end of the guiding elongated body,and the variable tip area has an ability of changing flexibility betweena first state in which the variable tip area has predeterminedflexibility and a second state in which the variable tip area is stifferthan the first state.

Since the stent delivery device according to the invention includes theguiding elongated body with the variable tip area capable of changingthe flexibility, the stent provided in the vicinity of the distal end ofthe catheter can be rapidly transported to the indwelling site and beindwelled at that site by changing the flexibility of the guidingelongated body depending on the procedure and the patient's internalbody condition.

Further, for example, the guiding elongated body may include apuncturing portion which is provided in the distal end of the guidingelongated body so as to puncture a wall of an organ.

In such a stent delivery device, since the puncturing portion can bestrongly pressed against the corresponding site by setting the variabletip area of the guiding elongated body to the second state, thepuncturing can be rapidly performed. Further, if the variable tip areaof the guiding elongated body is set to the first state when thepuncturing is not performed, it is possible to prevent the puncturingportion from being strongly pressed against a wall of an organ. Further,since the guiding elongated body has a function of a puncturing tool anda function of guiding the catheter like the guide wire, it is possibleto omit a replacement operation of a wire or the like inserted throughan inner lumen and to rapidly transport the stent to the indwellingsite.

For example, the puncturing portion may include an electrode forcauterizing a wall of an organ.

Since the puncturing portion having such an electrode does not need tohave a sharp tip due to the needle of the puncturing portion, such aguiding elongated body can prevent a site other than the punctured sitefrom being damaged by the puncturing portion. Further, since such aguiding elongated body is used, it is possible to more rapidly perform aprocedure and to transport a stent to the indwelling site.

The guiding elongated body may include an inner elongated body and anouter tube through which the inner elongated body is slidably inserted.

Such a guiding elongated body can easily change the variable tip areastate between the first state and the second state by sliding the innerelongated body and the outer tube.

Further, for example, when the variable tip area is in the first state,an exposure length in which the inner elongated body is exposed from adistal end of the outer tube may be a first length, and when thevariable tip area is in the second state, the exposure length may be asecond length shorter than the first length.

Such a guiding elongated body can rapidly and easily change the firststate and the second state, for example, in such a manner that the innerelongated body is exposed from the outer tube so that the variable tiparea becomes the first state and the inner elongated body isaccommodated in the outer tube so that the variable tip area becomes thesecond state.

Further, for example, when the variable tip area is in the first state,a non-overlapping length in which the outer tube and the inner elongatedbody do not overlap each other in the vicinity of the distal end of theguiding elongated body may be a third length, and when the variable tiparea is in the second state, the non-overlapping length may be a fourthlength shorter than the third length.

Such a guiding elongated body can rapidly and easily change the firststate and the second state from the proximal end side of the guidingelongated body, for example, in such a manner that the distal end of theinner elongated body is pulled to the proximal end side of the outertube so that the variable tip area becomes the first state and thedistal end of the inner elongated body is pushed to the distal end sideof the outer tube so that the variable tip area becomes the secondstate.

Further, for example, the outer tube may include a telescopic distal endportion which is provided in the vicinity of a distal end of the outertube and having elasticity in an axial direction while changing theflexibility.

Such a guiding elongated body including the outer tube can rapidly andeasily change the first state and the second state of the variable tiparea from the proximal end side of the guiding elongated body, forexample, in such a manner that the proximal end of the outer tube ismoved to the proximal end side to expand the telescopic distal endportion so that the variable tip area becomes the first state and theproximal end of the outer tube is moved to the distal end side tocontract the telescopic distal end portion so that the variable tip areabecomes the second state.

Further, the stent delivery device of the invention may further includean operation wire which is connected to the distal end of the guidingelongated body and inserted through the inner lumen of the inner sheathin parallel to the guiding elongated body, wherein the operation wire isused to operate bending and stretching in the vicinity of the distal endof the guiding elongated body.

Such a stent delivery device including the operation wire can rapidlyperform a procedure and rapidly transport the stent to the indwellingsite by allowing an operator to operate the bending and stretching ofthe distal end portion of the guiding elongated body.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic diagram illustrating an overall configuration of astent delivery device according to a first embodiment of the invention;

FIG. 2 is a perspective view illustrating a distal end portion of aguiding elongated body of the stent delivery device illustrated in FIG.1;

FIG. 3 is a perspective view illustrating a distal end portion of aguiding elongated body according to a modified example;

FIG. 4A is a side view illustrating a second state of a variable tiparea of the guiding elongated body of the stent delivery deviceillustrated in FIG. 1 and FIG. 4B is a side view illustrating a firststate of the variable tip area;

FIG. 5A is a side view illustrating a second state of a variable tiparea of a guiding elongated body of a stent delivery device according toa second embodiment of the invention and FIG. 5B is a side viewillustrating a first state of the variable tip area;

FIG. 6A is a side view illustrating a second state of a variable tiparea of a guiding elongated body of a stent delivery device according toa third embodiment of the invention and FIG. 6B is a side viewillustrating a first state of the variable tip area;

FIG. 7A is a side view illustrating a second state of a variable tiparea of a guiding elongated body of a stent delivery device according toa fourth embodiment of the invention and FIG. 7B is a side viewillustrating a first state of the variable tip area;

FIG. 8 is a diagram illustrating a puncturing operation using the stentdelivery device illustrated in FIG. 1;

FIG. 9 is a diagram illustrating a catheter guiding operation using thestent delivery device illustrated in FIG. 1; and

FIG. 10A is a side view illustrating a second state of a variable tiparea of a guiding elongated body of a stent delivery device according toa second modified example of the invention and FIG. 10B is a side viewillustrating a first state of the variable tip area.

DETAILED DESCRIPTION First Embodiment

Hereinafter, an embodiment of the invention will be described in detailwith reference to the drawings. In the embodiment, an exemplary case inwhich an ultrasonic endoscope-guided transgastric transhepatic biliarydrainage (EUS-BD), that is, a self-expanding stent provided with acovering film for bypass-connecting a stomach and an intrahepatic bileduct is indwelled and another stent is indwelled in the bile duct willbe described. However, the stent delivery device according to theinvention is not limited to one that bypass-connects the stomach and theintrahepatic bile duct and can be widely applied to those whichbypass-connect luminal organs and other luminal organs such as duodenumand common bile duct. Further, the stent delivery device according tothe invention is not limited to the case of indwelling a stent forbypass-connection and can be also applied to a transduodenal papillarybiliary drainage (for indwelling a stent at a stenosis in the commonbile duct) and one for indwelling a stent at a stenosis in a lumen otherthan the common bile duct.

As illustrated in FIG. 1, a stent delivery device 1 schematicallyincludes an elongated catheter 2 which is inserted into a patient's body(lumen) through a treatment instrument guide tube of an endoscope (notillustrated), an operation unit 3 which is connected to a proximal endside of the catheter 2 and operates the catheter 2 inside a body fromthe outside of the body, a guiding elongated body 4, a stent 5 which isan indwelling target, and a distal end tip 10. Although the vicinity ofthe distal end of the catheter 2 including the stent 5 may be curveddepending on the shape of the site to be indwelled, it is drawn linearlyfor convenience of the drawing.

The catheter 2 includes an inner sheath 21 which includes a distal endand a proximal end and an outer sheath 22 which includes a distal endand a proximal end. As illustrated in FIG. 1, the inner sheath 21 isinserted through the lumen of the outer sheath 22 so as to be slidable.

A contrast marker (not illustrated) is attached to the vicinity of thedistal ends of the inner sheath 21 and the outer sheath 22. The contrastmarker is a marker of which a position is detected by X-ray fluoroscopyand becomes a marker in the body. For example, the contrast marker isformed of a metal material such as gold, platinum, and tungsten or apolymer blended with barium sulfate or bismuth oxide.

The inner sheath 21 is formed as an elongated tube having flexibilityand the guiding elongated body 4 serving as a guide for inserting thecatheter 2 into a patient's body is inserted through an inner lumen 21 cwhich is a lumen thereof. The distal end of the catheter 2 can beinserted into a target site inside the body as the catheter 2 is pushed(moved forward) along the guiding elongated body 4 after the guidingelongated body 4 is inserted into the body to secure a path inside andoutside the body. The outer diameter of the inner sheath 21 (a portionfor disposing the stent 5 to be described later) is about 0.5 to 3.5 mm.

As illustrated in FIG. 4, the guiding elongated body 4 includes avariable tip area 45 and has another function of puncturing a wall of anorgan as well as a function of guiding the catheter 2 as in a normalguide wire. The variable tip area 45 and other functions of the guidingelongated body 4 will be described later. Additionally, the catheter 2may be inserted into the inner lumen 21 c by exchanging a guide wire, adilator, or another tube with the guiding elongated body 4.

As illustrated in FIG. 1, a fixing ring 25 is integrally fixed to thevicinity of the distal end of the inner sheath 21. The fixing ring 25 isused to define the position of the proximal end of the stent 5 and a gapbetween the inner sheath 21 and the outer sheath 22 in a portion fromthe fixing ring 25 to the distal end becomes a stent placement portion.The stent 5 is disposed in the stent placement portion. Further, aproximal end side portion in relation to the fixing ring 25 in the innersheath 21 is provided with another elongated tube (not illustrated)coaxially provided to cover an elongated tube constituting a body of theinner sheath 21 and a proximal end side portion in relation to thefixing ring 25 in the inner sheath 21 is thicker than a distal end sideportion in relation to the fixing ring 25 in the inner sheath 21. Inthis way, since the proximal end side portion in relation to the fixingring 25 in the inner sheath 21 is thick, the pushability of the innersheath 21 increases. Accordingly, the operability becomes satisfactoryand the deviation of the position of the fixing ring 25 toward theproximal end side is prevented.

The outer sheath 22 is formed as an elongated tube having flexibilityand has an inner diameter slightly larger than the outer diameter of theinner sheath 21. The inner sheath 21 is slidably inserted into the outersheath. The inner diameter of the outer sheath 22 is about 0.5 to 3.5 mmand the outer diameter thereof is about 1.0 to 4.0 mm. The outer sheath22 is slidable (relatively movable) in the axial direction with respectto the inner sheath 21 in such a manner that the operation unit 3connected to the proximal ends of the outer sheath 22 and the innersheath 21 is operated by an operator.

As the materials of the inner sheath 21 and the outer sheath 22, forexample, various resin materials including polyolefins such aspolyethylene and polypropylene, polyvinyl chloride, polyurethane,ethylene-vinyl acetate copolymer, polyester such as polyethyleneterephthalate and polybutylene terephthalate, polyamide, polyetherpolyamide, polyester polyamide, polyether ether ketone, polyether imideand fluorine-based resins such as polytetrafluoroethylene andtetrafluoroethylene/hexafluoropropylene copolymer, or variousthermoplastic elastomers such as polystyrene based elastomers,polyolefin based elastomers, polyurethane based elastomers, polyesterbased elastomers, polyamide based elastomers, and polybutadiene basedelastomers can be used. Two or more of these can be used in combination.Further, the inner sheath 21 and the outer sheath 22 may be respectivelyprovided with reinforcing materials formed in a blade shape or a coilshape by a wire formed of metal such as stainless steel or tungsten orhigh-rigidity resin such as liquid crystal polymer.

Additionally, although it is not provided in the embodiment, anoutermost tube (not illustrated) may be coaxially disposed on theoutside of the outer sheath 22. The outermost tube is formed as anelongated tube having flexibility and includes a lumen into which theouter sheath 22 is slidably inserted. As the outermost tube, one havinga size larger than the outer diameter of the outer sheath 22 by about0.05 to 1.0 mm can be used. As the material of the outermost tube,polyacetal, polytetrafluoroethylene,tetrafluoroethylene/hexafluoropropylene copolymer, polypropylene, or thelike can be used.

The stent 5 is a self-expanding stent which expands from its contractedstate by its own elastic force and has a cylindrical bare stent formedby a frame. A covered stent is used as a stent for bypass-connectionbetween organs and in addition to a bare stent, a covered stent has acovering film portion that covers the outer periphery of the bare stent.The bare stent is formed of super elastic metal such as nickel titaniumalloy, cobalt chromium alloy, gold titanium alloy, beta titanium alloy,or shape memory metal. In the case of the covered stent, the surface ofthe bare stent is covered with a coating that extends to fill betweenadjacent frames and the outer periphery of the bare stent covered withthe coating is covered by a covering film such as a polymer film.

Although the total length of the stent 5 is determined depending on theapplication such as the distance between the lumen organs to bebypass-connected, the total length is about 30 to 200 mm. Further,although the outer diameter in an expanded state is determined dependingon the type and size of the luminal organ to be bypass-connected, thesize of the lumen in which the stent 5 is indwelled, and the like, theouter diameter is about ϕ2 to ϕ20 mm. The outer diameter of the stent 5in a contracted state is about a fraction of the outer diameter in theexpanded state. Additionally, in the embodiment, the stent 5 isdescribed as one component of the stent delivery device 1, but the stent5 can be replaced as a member separated from the stent delivery device1.

The operation unit 3 connected to the proximal end of the stent 5includes a substantially cylindrical release handle (housing) 31, adistal end lid member having a penetration hole formed at the centerportion is integrally attached to the distal end side opening of therelease handle 31 so as to close the opening, and a proximal end lidmember having a penetration hole formed at the center portion thereof isintegrally attached to the proximal end side opening so as to close theopening.

The proximal end of the outer sheath 22 is slidably inserted through thepenetration hole of the distal end lid member of the release handle 31and the proximal end of the outer sheath 22 is located inside therelease handle 31. Further, the operation unit 3 includes a releaselever 32 which slidably engages with the release handle 31. The releaselever 32 includes a head portion which is located outside the releasehandle 31 and a foot portion which is formed uprightly at the centerportion of the head portion and is located inside the release handle 31.

The front end (the lower end) of the foot portion of the release lever32 is fixed to the proximal end of the outer sheath 22 located insidethe release handle 31. When the release lever 32 is slid, the outersheath 22 can be slid to the proximal end side or the distal end sidewith respect to the inner sheath 21 fixed to the release handle 31 (theproximal end lid member).

The proximal end of the inner sheath 21 inserted through the outersheath 22 passes through the release handle 31 and penetrates thepenetration hole of the proximal end lid member of the release handle 31so that its proximal end is located outside the release handle 31. Theinner sheath 21 is fixed to the proximal end lid member (the releasehandle 31) at the penetration hole portion.

In a state in which the release lever 32 is moved to the distal endside, as illustrated in FIG. 1, the distal end of the outer sheath 22reaches the distal end tip 10. Accordingly, in the stent delivery device1, the stent 5 is held inside the outer sheath 22 while being contractedat the stent placement portion of the inner sheath 21. When the releaselever 32 is moved to the proximal end side of the groove from thisstate, the outer sheath 22 is slid to the proximal end side with respectto the inner sheath 21 so that the stent 5 is relatively pushed out fromthe distal end of the outer sheath 22 and the stent 5 is released(expanded) by the self-expanding force.

The distal end tip 10 is attached to the distal end portion of the innersheath 21. When the distal end of the inner sheath 21 (the catheter 2)collides with the peripheral wall of the body lumen, the distal end tip10 reduces the stimulation on the body lumen and further reduces theinsertion resistance of the catheter 2 so that the insertion into thebody is facilitated. The distal end tip 10 is formed of, for example, aresin such as polyethylene (PE), polyamide (PA), or polyurethane (PU).

The distal end tip 10 is provided with a penetration hole communicatingwith the inner lumen 21 c of the inner sheath 21 and a part (a part inthe vicinity of the distal end) of the guiding elongated body 4 insertedthrough the inner lumen 21 c of the inner sheath 21 is exposed from thedistal end of the catheter 2 through the penetration hole of the distalend tip 10.

The guiding elongated body 4 can be used as a guide for inserting thecatheter 2 into the patient's body as illustrated in FIG. 1. The guidingelongated body 4 is inserted through the inner lumen 21 c of the innersheath 21 and is disposed so that its distal end protrudes from theopening of the distal end of the distal end tip 10 of the inner sheath21 and its proximal end is exposed to the outside through a proximal endopening 21 a of the inner sheath 21 disposed to penetrate the operationunit 3. The outer diameter of the guiding elongated body 4 can be set toabout 0.025 inch 0.635 mm) to 0.035 inch 0.889 mm) similarly to thediameter of the general guide wire. However, the guiding elongated body4 may have an outer diameter in which the inner sheath 21 can beinserted and may have an outer diameter different from the diameter ofthe general guide wire.

FIG. 2 is a perspective view illustrating a distal end portion of theguiding elongated body 4 illustrated in FIG. 1. The guiding elongatedbody 4 has a double tube structure including an inner elongated body 41which is a tubular body having an innermost lumen 41 c formed thereinand an outer tube 42 through which the inner elongated body 41 isslidably inserted. Further, an elongated body distal end tip 43 isprovided at the distal end of the guiding elongated body 4.

The elongated body distal end tip 43 includes an electrode 43 acauterizing a wall of an organ and constitutes a puncturing portioncapable of puncturing the wall of the organ. The elongated body distalend tip 43 has a truncated conical tip shape and the electrode 43 a isformed so as to surround an elongated body distal end opening 4 c formedin the upper end surface of the truncated cone. An electric potential istransmitted to the electrode 43 a through a wire 44, but when the innerelongated body 41 or the outer tube 42 is a sheath of a conductivematerial, these members can be used as the wire 44. The electrode 43 aillustrated in FIG. 2 is a monopolar type, but the electrode 43 a of theelongated body distal end tip 43 may be a bipolar type.

Further, the elongated body distal end opening 4 c illustrated in FIG. 2communicates with the innermost lumen 41 c of the inner elongated body41. The guiding elongated body 4 can flush the contrast agent introducedinto the innermost lumen 41 c from the proximal end side of the innerelongated body 41 into the body from the elongated body distal endopening 4 c.

As the inner elongated body 41 with the innermost lumen 41 c or theouter tube 42, a coil tube formed by spirally winding a metal wire suchas a stainless steel wire, a flexible metal pipe formed by cutting ametal pipe by laser beam processing or etching, a resin tube formed ofPTFE or other resin, and the like can be used. Further, the elongatedbody distal end tip 43 can be formed by the electrode 43 a, the wire 44,and resin covering them.

As illustrated in FIG. 1, the proximal end of the guiding elongated body4 is exposed from the inner lumen 21 c through the proximal end opening21 a of the inner sheath 21 and is connected to a slide operation unit7. The slide operation unit 7 is an operation unit for changing theflexibility of the variable tip area (see FIG. 4) of the guidingelongated body 4. The operator operates a lever provided in the slideoperation unit 7 so as to move the outer tube 42 and the inner elongatedbody 41 illustrated in FIGS. 2 and 4 in the axial direction.Accordingly, the flexibility of the variable tip area 45 can be easilyand rapidly changed between a first state and a second state.

A wiring cord connected to a generator 8 supplying power to the wire 44of the guiding elongated body 4 is connected to the slide operation unit7 and an electric potential is transmitted from the proximal end of theguiding elongated body 4 to the electrode 43 a provided in the distalend of the guiding elongated body 4.

FIG. 4A is a side view illustrating the second state of the variable tiparea 45 of the guiding elongated body 4 and FIG. 4B is a side viewillustrating the first state of the variable tip area 45. The guidingelongated body 4 includes the variable tip area 45 which is provided inthe vicinity of the distal end of the guiding elongated body 4, and thevariable tip area 45 has an ability of changing the flexibility by theoperation of the slide operation unit 7 connected to the proximal end.In the guiding elongated body 4, when the outer tube 42 is pulled towardthe proximal end side with respect to the fixed inner elongated body 41as indicated by an arrow of FIG. 4B, the inner elongated body 41 isexposed from the distal end of the outer tube 42.

As illustrated in FIG. 4B, when the variable tip area 45 of the guidingelongated body 4 is in the first state, the inner elongated body 41 isexposed from the distal end of the outer tube 42 and the exposure lengthis a first length. As illustrated in FIG. 4B, the variable tip area 45in the first state has predetermined flexibility. When the distal end ofthe guiding elongated body 4 contacts a wall of an organ 78, thevariable tip area 45 is easily bent and the distal end of the guidingelongated body 4 moves along the wall of the organ 78. The flexibilityof the variable tip area 45 in the first state is the same as theflexibility of the inner elongated body 41 alone exposed from the outertube 42 and, for example, the flexibility of the inner elongated body 41can be set to be substantially the same as that of the general guidewire.

As illustrated in FIG. 4A, when the variable tip area 45 of the guidingelongated body 4 is in the second state, the exposure length in whichthe inner elongated body 41 is exposed from the distal end of the outertube 42 is a second length shorter than the first length in the firststate. In this case, a state in which the exposure length is the secondlength includes a state in which the inner elongated body 41 is notexposed from the distal end of the outer tube 42 (a state in which theexposure length is 0). As illustrated in FIG. 4A, the variable tip area45 in the second state is stiffer than the first state. Even when thedistal end of the guiding elongated body 4 contacts a wall of an organ,the variable tip area 45 is not easily bent and the distal end of theguiding elongated body 4 can be pressed against the wall of the organ.

The flexibility of the variable tip area 45 in the second state is thesame as the flexibility of the proximal end side portion in relation tothe variable tip area 45 of the guiding elongated body 4 (a portion inwhich the outer tube 42 and the inner elongated body 41 with theinnermost lumen 41 c are double tubes). For example, the flexibility ofthe portion in which the outer tube 42 and the inner elongated body 41are double tubes can be set to the flexibility lower than that of thegeneral guide wire. Additionally, the distal end portion of the innerelongated body 41 is provided with a precurved bending and the bendingis corrected by the rigidity of the outer tube 42 in the outer tube 42so that the distal end portion of the inner elongated body 41 has alinear shape. When the distal end portion is exposed from the outer tube42, the distal end portion of the inner elongated body 41 may be curveddue to the bending.

Since the stent delivery device 1 including the guiding elongated body 4changes the flexibility of the variable tip area 45 of the guidingelongated body 4 depending on the internal body condition in thevicinity of the distal end of the stent delivery device 1 or theprocedure thereof, it is possible to shorten the time necessary for theprocedure and to rapidly transport and indwell the stent 5 to theindwelling site.

For example, FIG. 8 illustrates one procedure using the stent deliverydevice 1 and illustrates a procedure of puncturing a stomach wall 71 anda bile duct wall 72 interposing an abdominal cavity 75 therebetween. Inthe procedure illustrated in FIG. 8, first, as illustrated in FIG. 4A,when the guiding elongated body 4 is set to the second state, theelectrode 43 a (see FIG. 2) provided in the distal end of the guidingelongated body 4 is pressed against the stomach wall 71 and cauterizesand punctures the stomach wall 71. Further, when the guiding elongatedbody 4 is further pushed outward while the variable tip area 45 ismaintained in the second state in which the variable tip area is stifferand hardly bent, the guiding elongated body 4 penetrates the puncturedhole of the stomach wall 71 so that the distal end of the guidingelongated body 4 reaches the bile duct wall 72. Further, when the bileduct wall 72 is also punctured similarly to the stomach wall 71 and theguiding elongated body 4 is pushed inward while the variable tip area 45is maintained in the second state, the guiding elongated body 4 can belocated inside a bile duct 76.

FIG. 9 is a diagram illustrating another procedure using the stentdelivery device 1 and illustrating a procedure performed after theprocedure illustrated in FIG. 8. In the procedure illustrated in FIG. 9,first, as illustrated in FIG. 4B, the guiding elongated body 4 is set tothe first state. Then, when the guiding elongated body 4 is furtherinserted into the body after the guiding elongated body 4 is set to thefirst state, the distal end of the guiding elongated body 4 can be movedto the indwelling position of the stent 5 inside the bile duct 76 alongthe bile duct wall 72 (the inner wall). Subsequently, the catheter 2 isinserted into the bile duct 76 along the guiding elongated body 4 andthe stent 5 can be transported and indwelled to the indwelling position.

In this way, in the stent delivery device 1, when the variable tip area45 of the guiding elongated body 4 is set to the second state, theelectrode 43 a located at the distal end of the guiding elongated body 4can be strongly pressed against the punctured site and hence thepuncturing can be rapidly performed. Further, if the variable tip area45 of the guiding elongated body 4 is set to the first state when thepuncturing is not performed, it is possible to prevent the distal end ofthe guiding elongated body 4 from being strongly pressed against a wallof an organ, such as the bile duct wall 72 or the like. Further, sincethe guiding elongated body 4 has the function of a puncturing tool ordilator and the function of guiding the catheter 2 like a guide wire, itis possible to omit a replacement operation (a procedure) of a wire orthe like inserted through the inner lumen 21 c (see FIG. 1) of thecatheter 2 and to rapidly transport the stent 5 to the indwellingposition.

Second Embodiment

FIG. 5A is a side view illustrating a second state of a variable tiparea 245 of a guiding elongated body 204 of a stent delivery deviceaccording to a second embodiment of the invention and FIG. 5B is a sideview illustrating a first state of the variable tip area 245. The stentdelivery device according to the second embodiment is different from thestent delivery device 1 according to the first embodiment in that anoperation wire 206 operating the direction of the distal end of theguiding elongated body 204 is provided and a method of changing theflexibility of the variable tip area 245 is different. However, thestent delivery device according to the second embodiment is the same asthe stent delivery device 1 according to the first embodiment except forthese different points. Thus, in the description of the stent deliverydevice according to the second embodiment, only the different points ofthe stent delivery device 1 will be described and the description of thecommon points with the stent delivery device 1 will be omitted.

As illustrated in FIGS. 5A and 5B, the guiding elongated body 204includes the inner elongated body 41, the outer tube 42 through whichthe inner elongated body 41 is slidably inserted, and the elongated bodydistal end tip 43 similarly to the guiding elongated body 4 illustratedin FIGS. 4A and 4B. However, in the guiding elongated body 204, when theinner elongated body 41 is pushed to the distal end side of the fixedouter tube 42 as indicated by an arrow of FIG. 5B, the inner elongatedbody 41 is exposed from the distal end of the outer tube 42.

The first state of the variable tip area 245 of the guiding elongatedbody 204 illustrated in FIG. 5B is the same as the first state of thevariable tip area 45 of the guiding elongated body 4 illustrated in FIG.4B and the second state of the variable tip area 245 of the guidingelongated body 204 illustrated in FIG. 5A is the same as the secondstate of the variable tip area 45 of the guiding elongated body 4illustrated in FIG. 4A.

As illustrated in FIGS. 5A and 5B, the distal end of the operation wire206 is connected to the elongated body distal end tip 43 of the guidingelongated body 204. The operation wire 206 is inserted through the innerlumen 21 c of the inner sheath 21 of the catheter 2 (see FIG. 1) inparallel to the guiding elongated body 204. The proximal end of theoperation wire 206 is exposed from the proximal end opening 21 a of theinner sheath 21 to the outside and the operator of the stent deliverydevice can operate the bending and stretching of the distal end of theguiding elongated body 4 by operating the proximal end of the operationwire 206 in the axial direction.

The stent delivery device including such an operation wire 206 canrapidly transport the stent 5 to the indwelling site by rapidlyperforming a procedure in such a manner that the operator operates thebending and stretching in the vicinity of the distal end of the guidingelongated body 204. Further, the stent delivery device according to thesecond embodiment has the same effect as that of the stent deliverydevice according to the first embodiment.

Third Embodiment

FIG. 6A is a side view illustrating a second state of a variable tiparea 345 of a guiding elongated body 304 of a stent delivery deviceaccording to a third embodiment of the invention and FIG. 6B is a sideview illustrating a first state of the variable tip area 345. The stentdelivery device according to the third embodiment is the same as thestent delivery device 1 according to the first embodiment except thatthe structure of the distal end portion of the guiding elongated body304 is different. Thus, in the description of the stent delivery deviceaccording to the third embodiment, only the different points from thestent delivery device 1 will be described and the description of thecommon points with the stent delivery device 1 will be omitted.

As illustrated in FIGS. 6A and 6B, the guiding elongated body 304includes an inner elongated body 341 which is a wire, an outer tube 342through which the inner elongated body 341 is slidably inserted, and anelongated body distal end tip 343. The elongated body distal end tip 343is different from the elongated body distal end tip 43 according to thefirst embodiment in that the elongated body distal end tip is connectedto the outer tube 342, but is the same as the elongated body distal endtip 43 illustrated in FIG. 2 in that the elongated body distal end tipincludes the electrode 43 a.

As illustrated in FIG. 6B, when the variable tip area 345 of the guidingelongated body 304 is in the first state, the distal end of the innerelongated body 341 is pressed to the proximal end side with respect tothe distal end of the outer tube 342. Thus, when the variable tip area345 of the guiding elongated body 304 is in the first state, anon-overlapping portion of the outer tube 342 and the inner elongatedbody 341 is formed in the vicinity of the distal end of the guidingelongated body 304 and a non-overlapping length corresponding to thelength of that portion is a third length. The outer tube 342 includes acoiled portion 342 a which is formed in a portion where the variable tiparea 345 is located and which is formed as a coil tube formed of a metalwire so that a tube wall is spirally wound. The flexibility of thevariable tip area 345 in the first state is the same as the flexibilityof the coiled portion 342 a alone in the outer tube 342 from which theinner elongated body 341 is pulled out.

As illustrated in FIG. 6A, when the variable tip area 345 of the guidingelongated body 304 is in the second state, a non-overlapping length inwhich the outer tube 342 does not overlap the inner elongated body 341is a fourth length shorter than the third length in the first state. Inthis case, a state in which the non-overlapping length is the fourthlength includes a state in which the inner elongated body 341 matchesthe distal end of the outer tube 342 (a state in which thenon-overlapping length is 0). The variable tip area 345 corresponding tothe second state illustrated in FIG. 6A is stiffer than the variable tiparea 345 corresponding to the first state illustrated in FIG. 6Bsimilarly to the variable tip area 45 of the guiding elongated body 4described with reference to FIGS. 4A and 4B. Additionally, in the thirdembodiment of the invention, in order to allow the inner elongated body341 to have rigidity as large as possible, the inner elongated body 341is desirably a wire not including a lumen formed therein. For example, awire formed of metal such as stainless steel can be used.

When the inner elongated body 341 is pulled toward the proximal end sidewith respect to the fixed outer tube 342 as indicated by an arrow ofFIG. 6B, the variable tip area 345 of the guiding elongated body 304changes from the second state illustrated in FIG. 6A to the first stateillustrated in FIG. 6B. The stent delivery device according to the thirdembodiment with such a guiding elongated body 304 has the same effect asthat of the stent delivery device 1 according to the first embodiment.

Fourth Embodiment

FIG. 7A is a side view illustrating a second state of a variable tiparea 445 of a guiding elongated body 404 of a stent delivery deviceaccording to a fourth embodiment of the invention and FIG. 7B is a sideview illustrating a first state of the variable tip area 445. The stentdelivery device according to the fourth embodiment is the same as thestent delivery device 1 according to the first embodiment except thatthe structure of the distal end portion of the guiding elongated body404 is different. Thus, in the description of the stent delivery deviceaccording to the fourth embodiment, only the different points from thestent delivery device 1 will be described and the description of thecommon points with the stent delivery device 1 will be omitted.

As illustrated in FIGS. 7A and 7B, the guiding elongated body 404includes an inner elongated body 441, an outer tube 442 through whichthe inner elongated body 441 is slidably inserted, and an elongated bodydistal end tip 443. Since the elongated body distal end tip 443 isconnected to both of the inner elongated body 441 and the outer tube442, this elongated body distal end tip is different from the elongatedbody distal end tip 43 according to the first embodiment, but is thesame as the elongated body distal end tip 43 illustrated in FIG. 2 inthat the electrode 43 a is provided.

As illustrated in FIGS. 7A and 7B, the outer tube 442 includes atelescopic distal end portion 442 a provided in the vicinity of thedistal end of the outer tube 442 and having elasticity in the axialdirection while changing the flexibility. The telescopic distal endportion 442 a is formed as a coil tube formed of a metal wire so that atube wall is spirally wound.

As illustrated in FIG. 7B, when the variable tip area 445 of the guidingelongated body 404 is in the first state, the telescopic distal endportion 442 a of the outer tube 442 is expanded in the axial direction.Accordingly, the flexibility of the telescopic distal end portion 442 ais higher than that of the second state in which the telescopic distalend portion 442 a is contracted.

In contrast, as illustrated in FIG. 7A, when the variable tip area 445of the guiding elongated body 404 is in the second state, the telescopicdistal end portion 442 a of the outer tube 442 is contracted in theaxial direction. Accordingly, the flexibility of the telescopic distalend portion 442 a is lower than that of the first state in which thetelescopic distal end portion 442 a is expanded.

In the variable tip area 445 of the guiding elongated body 404, theflexibility of the outer tube 442 with the telescopic distal end portion442 a changes between the first state and the second state as describedabove and the flexibility of the inner elongated body 441 does notchange. Thus, the variable tip area 445 in the second state illustratedin FIG. 7A is stiffer than the variable tip area 445 corresponding tothe first state illustrated in FIG. 7B similarly to the variable tiparea 45 of the guiding elongated body 4 described with reference toFIGS. 4A and 4B.

The variable tip area 445 of the guiding elongated body 404 changes fromthe second state illustrated in FIG. 7A to the first state illustratedin FIG. 7B when the inner elongated body 441 is pushed toward the distalend side while the proximal end of the outer tube 442 is fixed. Thestent delivery device according to the fourth embodiment with such aguiding elongated body 404 has the same effect as that of the stentdelivery device 1 according to the first embodiment.

As described above, the invention has been described with reference tothe embodiments, but the invention is not limited to the above-describedembodiments. It is needless to mention that many other embodiments andmodifications are included. For example, FIG. 3 is a perspective viewillustrating the distal end portion of a guiding elongated body 104according to the modified example. The guiding elongated body 104 is thesame as the guiding elongated body 4 except that the elongated bodydistal end tip 143 is different from the elongated body distal end tip43 of the guiding elongated body 4 illustrated in FIG. 2.

As illustrated in FIG. 3, the elongated body distal end tip 143 providedin the distal end of the guiding elongated body 104 includes a needle143 a capable of puncturing a wall of an organ while being pressedagainst the wall of the organ with a predetermined force. Such a guidingelongated body 104 can have a function of a puncturing tool and afunction of guiding the catheter 2 by changing the flexibility of thevariable tip of the guiding elongated body 104. Further, as the guidingelongated body of the stent delivery device of the invention, theinvention is not limited to one having a puncturing portion provided atits distal end. For example, it may have a function other thanpuncturing, such as a dilator that expands a puncture hole or may haveonly a function of guiding a catheter.

FIG. 10A is a side view illustrating a second state of a variable tiparea 545 of a guiding elongated body 504 of a stent delivery deviceaccording to a second modified example of the invention and FIG. 10B isa side view illustrating a first state of the variable tip area 545. Thestent delivery device according to the second modified example is thesame as the stent delivery device according to the third embodimentillustrated in FIGS. 6A and 6B except that the guiding elongated body504 includes a covering tube 511. Thus, in the description of the stentdelivery device according to the second modified example, only thedifferent points from the stent delivery device according to the thirdembodiment will be described and the description of the common pointswith the stent delivery device according to the third embodiment will beomitted.

As illustrated in FIGS. 10A and 10B, the guiding elongated body 504includes the covering tube 511 which covers the outer periphery of thedistal end part of the guiding elongated body 504. The outer tube 342and the inner elongated body 341 are inserted through the covering tube511 and the elongated body distal end tip 343 provided in the distal endof the outer tube 342 is exposed from the distal end of the coveringtube 511.

Since the covering tube 511 covers the outer periphery of the coiledportion 342 a of the guiding elongated body 504, it is possible toprevent the coiled portion 342 a from directly contacting a wall of anorgan. For example, as illustrated in FIG. 10B, when the guidingelongated body 504 is in the first state, the coiled portion 342 a ispartially expanded and contracted to exhibit the flexibility. However,when the covering tube 511 covers the coiled portion 342 a, it ispossible to prevent a problem in which the expanded and contractedportion of the coiled portion 342 a is caught by a wall of an organ.Further, since the covering tube 511 guides the bending of the coiledportion 342 a, it is possible to prevent a force in the bendingdirection from being concentrated on only a part of the coiled portion342 a and to prevent the coiled portion 342 a from being bent in adirection unexpected to the operator.

As the covering tube 511, for example, a resin tube having flexibilitycan be exemplified and the covering tube 511 can be formed of the samematerial as those of the inner sheath 21 and the outer sheath 22.Further, the stent delivery device including the guiding elongated body504 illustrated in FIGS. 10A and 10B has the same effect as that of thestent delivery device according to the third embodiment.

EXPLANATIONS OF LETTERS OR NUMERALS

-   -   1 STENT DELIVERY DEVICE    -   2 CATHETER        -   21 INNER SHEATH            -   21 a PROXIMAL END OPENING            -   21 c INNER LUMEN        -   22 OUTER SHEATH        -   25 FIXING RING    -   3 OPERATION UNIT        -   31 RELEASE HANDLE        -   32 RELEASE LEVER    -   4, 104, 204, 304, 404, 504 GUIDING ELONGATED BODY    -   4 c, 104 c ELONGATED BODY DISTAL END OPENING    -   41, 341, 441 INNER ELONGATED BODY    -   41 c INNERMOST LUMEN    -   42, 342, 442 OUTER TUBE    -   342 a COILED PORTION    -   442 a TELESCOPIC DISTAL END PORTION    -   43, 143, 343, 443 ELONGATED BODY DISTAL END TIP    -   43 a ELECTRODE    -   143 a NEEDLE    -   44 WIRE    -   45, 245, 345, 445, 545 VARIABLE TIP AREA    -   5 STENT    -   10 DISTAL END TIP    -   206 OPERATION WIRE    -   7 SLIDE OPERATION UNIT    -   8 GENERATOR    -   71 STOMACH WALL    -   72 BILE DUCT WALL    -   75 ABDOMINAL CAVITY    -   76 BILE DUCT    -   78 WALL OF ORGAN    -   511 COVERING TUBE

What is claimed is:
 1. A stent delivery device comprising: a catheterincluding an inner sheath and an outer sheath allowing the inner sheathto be slidably inserted therethrough; a stent provided between the innersheath and the outer sheath in the vicinity of a distal end of thecatheter; and a guiding elongated body inserted through an inner lumenof the inner sheath and is partially capable of exposed from the distalend of the catheter so as to guide the insertion of the catheter,wherein the guiding elongated body has a variable tip area provided inthe vicinity of a distal end of the guiding elongated body, and thevariable tip area has an ability of changing flexibility between a firststate in which the variable tip area has predetermined flexibility and asecond state in which the variable tip area is stiffer than the firststate, wherein the guiding elongated body includes a puncturing portionprovided in the distal end of the guiding elongated body so as topuncture a wall of an organ, and wherein the puncturing portion includesa needle configured to puncture the wall of the organ.
 2. The stentdelivery device according to claim 1, wherein the guiding elongated bodyincludes an inner elongated body and an outer tube through which theinner elongated body is slidably inserted.
 3. The stent delivery deviceaccording to claim 2, wherein when the variable tip area is in the firststate, an exposure length in which the inner elongated body is exposedfrom a distal end of the outer tube is a first length, and wherein whenthe variable tip area is in the second state, the exposure length is asecond length shorter than the first length.
 4. The stent deliverydevice according to claim 2, wherein when the variable tip area is inthe first state, a non-overlapping length in which the outer tube andthe inner elongated body do not overlap each other in the vicinity ofthe distal end of the guiding elongated body is a third length, andwherein when the variable tip area is in the second state, thenon-overlapping length is a fourth length shorter than the third length.5. The stent delivery device according to claim 2, wherein the outertube includes a telescopic distal end portion which is provided in thevicinity of a distal end of the outer tube and having elasticity in anaxial direction while changing the flexibility.
 6. The stent deliverydevice according to claim 1, further comprising: an operation wireconnected to the distal end of the guiding elongated body and insertedthrough the inner lumen of the inner sheath in parallel to the guidingelongated body, wherein the operation wire is used to operate bendingand stretching in the vicinity of the distal end of the guidingelongated body.
 7. The stent delivery device according to claim 2,further comprising: an operation wire connected to the distal end of theguiding elongated body and inserted through the inner lumen of the innersheath in parallel to the guiding elongated body, wherein the operationwire is used to operate bending and stretching in the vicinity of thedistal end of the guiding elongated body.
 8. The stent delivery deviceaccording to claim 3, further comprising: an operation wire connected tothe distal end of the guiding elongated body and inserted through theinner lumen of the inner sheath in parallel to the guiding elongatedbody, wherein the operation wire is used to operate bending andstretching in the vicinity of the distal end of the guiding elongatedbody.
 9. The stent delivery device according to claim 4, furthercomprising: an operation wire connected to the distal end of the guidingelongated body and inserted through the inner lumen of the inner sheathin parallel to the guiding elongated body, wherein the operation wire isused to operate bending and stretching in the vicinity of the distal endof the guiding elongated body.
 10. The stent delivery device accordingto claim 5, further comprising: an operation wire connected to thedistal end of the guiding elongated body and inserted through the innerlumen of the inner sheath in parallel to the guiding elongated body,wherein the operation wire is used to operate bending and stretching inthe vicinity of the distal end of the guiding elongated body.